Genetic testing for alpha1-antitrypsin deficiency may be considered medically necessary when either of the following conditions are met:
Individual is suspected of having alpha1-antitrypsin deficiency because of clinical factors and/or because the individual may be at high risk of having alpha1-antitrypsin deficiency due to a first-degree relative with alpha1-antitrypsin deficiency (see Policy Guidelines section); OR
Individual has a serum alpha1-antitrypsin level in the range of severe deficiency (see Policy Guidelines section).
Genetic testing for alpha1-antitrypsin deficiency is considered investigational in all other situations.
